Breastfeeding twice as likely after home births than hospital births

A new study by academics in Trinity College Dublin has found that there is a strong positive relationship between planned birth at home and breast feeding: breastfeeding was twice as likely after planned home births compared to hospital births. The research involved the largest population cohorts comprehensively examined to date for an association between breast feeding outcomes and place of birth in low risk pregnancies.

The study from Trinity’s Department of Public Health and Primary Care, which included over 10,500 women from the ‘Growing Up in Ireland’ study and 17,500 women from the UK Millennium Cohort Study found:

• Home birth is significantly associated with breastfeeding immediately after birth, and with continued breast feeding during the first 6 months.
• Home birth mothers were more likely to exclusively breastfeed for 6 months (22% vs 9%).

Ireland has significantly lower rates of breastfeeding with only 60% of women starting breastfeeding as against a European norm of around 90%. This is in spite of World Health Organisation (WHO) guidelines which recommend exclusive breastfeeding for the first six months of life.

Based on the collected data and on an analysis of factors surrounding home and hospital based birth, the study’s researchers suggest a number of potential reasons for the stronger association between breastfeeding and home birth:

• The level of support and type of care offered by each birth option is very different. In a home birth, care is typically midwife-led as opposed to physician-led. In Ireland, a self-employed community midwife is the primary carer for mother and child until the baby is 14 days old. As a result, the mother receives support and consistent advice from the same midwife throughout the first two weeks post-partum. In contrast, multiple health professionals are involved in care following hospital birth, potentially providing unpredictable and inconsistent input. There is also a difference in the level of training related to lactation amongst carers with midwives typically receiving more education in this area.
• Support in the early post-partum period has been shown to improve maternal and infant outcomes. In Ireland, the default model of care involves shared care between the obstetrician and GP followed by a visit from a public health nurse (PHN) which should take place within 48 hours of discharge. However, the percentage of first visits actually achieved varies significantly, from 57% to 87%. In contrast, the community midwives consistently support the mother and infant for the first two weeks, including immediately after birth when breast feeding is initiated.
• The non-clinical setting of a home birth can facilitate immediate and prolonged skin to skin contact post-partum, which is widely considered to have a positive effect on the initiation of breastfeeding and mother infant bonding.
• Interventions such as forceps or vacuum-assisted delivery that occur more frequently during labour in hospital may be stressful, and stress during birth has been linked to stalled breast feeding. Similarly, hospital births are associated with greater usage of pain-relieving medications, which can cause lethargy in the infant and delay milk production in the mother.
• It has been shown that formula supplementation in the early postnatal period reduces the likelihood of subsequent exclusive breast feeding and overall duration of breast feeding. Despite all Irish maternity units participating in the Baby Friendly Health Initiative, part of which recommends that newborns should not receive any food or drink other than breast milk unless medically indicated, hospital births have been associated with formula supplementation. This may be due to busy, understaffed clinical settings, where formula feeding may be found to be a more convenient solution to feeding problems than diagnosis and treatment of breast feeding issues.

Principal researcher on the study, Associate Professor of Epidemiology in Trinity, Dr Lina Zgaga, said: “The key question that this work raises is: “When breastfeeding is so strongly recommended across the board by the medical profession, what causes lower rates of breastfeeding following hospital births? Hopefully this research can help us learn from the home birth model and identify the changes that could be implemented in standard hospital-based perinatal care to encourage and facilitate breastfeeding.”

Dr Clare Quigley, the main analyst of the study said: “The self-reported home birth rate we observed for the Irish cohort (1.48%) was similar to the UK rate (2%), but more than seven times the rate reported in Irish government-published data (0.2%). The government data may report a lower rate as it includes only planned home births that were attended to by an independent midwife, but excludes home births that took place as part of hospital-administered home birth schemes.”

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